Eligibility requirements for both MAGI and Non-MAGI Medicaid applicants remain the same. However, the application procedures for Non-MAGI Medicaid and program requirements have been modified under COVID-19.
If you are a Benefits Plus Online subscriber, and want additional information on Medicaid, refer to Benefits Plus Online, Health Programs, Medicaid. For subscription information visit: https://bplc.cssny.org/home/subscription_options.
No Cost Sharing for COVID-19 Testing & Treatment
Medicaid must cover, without any cost-sharing expenses, the following: COVID-19 testing, testing-related services, and COVID-19 related treatment for Medicaid enrollees, which include vaccines, specialized equipment and therapies.
Effective December 13, 2021, Medicaid, is also covering over-the-counter FDA-approved at-home rapid antigen tests. This applies to both fee-for-service Medicaid, as well as to Medicaid managed care plans. Covered test kits must be authorized for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation. Pharmacists can order the at-home kits for the patients.
Changes in Non-MAGI Application Procedures
Applicants applying for Medicaid as MAGI households continue to submit an application via the NY State of Health at https://nystateofhealth.ny.gov/ or by calling 1-855-355-5777, there is no change.
DEFINING NON-MAGI MEDICAID APPLICANTS
The following individuals are classified as non-MAGI Medicaid:
- Individuals 65 or over;
- Disabled individuals with Medicare;
- Blind individuals with Medicare.
There is an exception, an individual/couple who is aged, disabled or blind with Medicare who is a parent or caretaker relative with children under 19 or who is pregnant may be classified as MAGI Medicaid.
To learn more about non-MAGI vs. MAGI Medicaid, refer to Benefits Plus Online, Health Programs, Medicaid, MAGI Medicaid vs. Non-MAGI Medicaid.
Additional guidance is found at https://health.ny.gov/health_care/medicaid/covid19/factsheets/eng_guide_med_cons_enrolled_thru_ldss.htm.
Closure of Some Local Medicaid Offices
Some local Medicaid offices remain closed for in-person assistance. In NYC, at least one office remains open in each borough for in-person emergencies. To find open locations, visit: https://www1.nyc.gov/site/hra/locations/medicaid-locations.page.
The Medicaid application is the DOH-4220, Access NY Health Care and the DOH-5178A, Supplement A. Effective January 1, 2021, Supplement A, is required for all non-MAGI Medicaid applications, not only for those applying for Community Based Long Term Care Services or Institutional Medicaid.
- DOH-4220: https://www.health.ny.gov/forms/doh-4220.pdf
- Supplement A: https://www.health.ny.gov/forms/doh-5178a.pdf
- Spanish DOH – 4220: https://www.health.ny.gov/forms/doh-4220_es.pdf
Submitting an Application Via Fax
During the COVID-19 emergency, non-MAGI Medicaid applicants are able to submit a Medicaid application via fax to 917-639-0732. In addition, young adults under age 26 who were formerly in foster care may submit an application via fax.
Individuals who have an immediate need for home care, can fax their application and home care request to 917-639-0665.
Submitting an Application via Facilitated Enrollers
Non-MAGI Medicaid applicants may also contact a facilitated enroller (FE) to apply for Medicaid via telephone. The FE, community-based organizations contracted by NYS to assist the aged, blind and disabled population with application/ recertification assistance, must send the individual a copy of the Medicaid application to use during the required telephone interview, as well as the DOH form 5147, Submission of Application on Behalf of Applicant, which allows the FE to sign the application on the applicant’s behalf. Both these forms can be sent by standard mail or by email, if acceptable to the applicant.
The applicant must sign and return both documents prior to conducting the interview. The form can be scanned and emailed back to the FE ABD agency.
Applicants can attest to all elements of eligibility except immigration status and identity, if the immigration document does not also prove identity, see below, Documentation.
A listing of Facilitated Enrollers in NYC can be found here. The following agencies serve as facilitated enrollers in NYS:
- Community Service Society – 888- 614-5400 https://www.cssny.org/programs/entry/facilitated-enrollment-for-the-aged-blind-and-disabled-program-fe-abd
- Public Health Solutions – 646-619-6759
- Nassau/Suffolk Hospital Council – 631-656-9783
- Western New York Independent Living – 716-836-0822 ext. 130
During the COVID-19 emergency, if an applicant has missing information, their local district will attempt to contact them via phone or e-mail (the district does not need to receive the information in writing and can accept information verbally).
If the local district is unable to contact the individual, the local district will send a written request for the missing information with a due date of no less than 10 days.
Local districts must allow for self-attestation for all eligibility criteria, except for immigration status and identity, if the immigration document does not also prove identity. Applicants that need to prove immigration status/identity should submit the required copies of documentation. However, if an applicant is not able to submit documentation due to the COVID-19 emergency, the application should still be submitted and processed. Applicants will be granted a 90-day reasonable opportunity to provide the required documents. If the COVID-19 emergency has not ended and supporting documents have not been received at the end of the reasonable opportunity period, coverage should be extended for a second 90-day period.
Applicants whose citizenship status is not verified through data sources will be given an opportunity to submit documents later.
Self-attestation applies to both initial applications or for a request for an increased coverage and redetermination.
Self-Attestation for Nursing Home Level of Care
In addition, individuals applying for Medicaid coverage of nursing home care can attest to income and resources during this emergency, including attesting to any transfer of assets in the look-back period.
The use of the Asset Verification System (AVS) provides the agency with bank account and real property information. Documentation is only required when information is not available in AVS or for incapacitated individuals that cannot consent to AVS.
Individuals in need of a disability determination, for example to establish a supplemental needs trust, should contact their local district to assist with the necessary documentation to process the disability determination.
WAIVING OF APPLICAITON REQUIREMENTS
Application for Other Benefits
During the COVID-19 emergency, applicants will not be required to apply for Medicare, or Social Security; in addition, referrals for Veterans benefits have been suspended. This requirement is waived for the period of the COVID-19 emergency.
Child Support Requirements
Medicaid recipients are not required to comply with child support requirements to apply for or maintain Medicaid coverage. Clients can call 929-221-7676 or email email@example.com , or write to the NYC Office of Child Support Services, PO Box 830, Canal Street Station, New York, NY 10013 and state their willingness to comply. Clients should provide their name, case number and contact information. Demonstrated compliance is suspended until further notice.
Third Party Health Insurance
Applicants will not be required to provide third party health insurance information and local districts are not required to make new cost-effective determinations for possible reimbursement.
If a signature on the Access NY Application and/or Supplement A cannot be signed by the applicant (or the applicant’s spouse) and the applicant is in a hospital or nursing home, the application can be signed by someone acting on behalf of the individual. The individual who is signing on behalf of the application must complete Submission of Application on Behalf of Applicant (DOH-5147 for NYS (http://coverage4healthcare.org/insurance_over_65/authorized_representative.pdf); MAP3044 for NYC) and must note the applicant cannot sign the form due to access issues/COVID-19 emergency.
If the applicant can sign the application, then the applicant must sign the DOH-5147 themselves to authorize another person or the facility to apply on behalf of the individual.
Changes in Medicaid Renewals
NYS’ Medicaid GIS on Medicaid Eligibility Processes During the Emergency Period
All cases due to expire during the months of March 2020 through January 31, 2023 are extended for 12 months. Cases will NOT be closed for failure to renew or for failure to provide documentation unless the individual voluntarily cancels their Medicaid or moves out of NYS.
This provision applies regardless of any changes in circumstances that would otherwise have resulted in coverage termination. Individuals do not need to take any action to keep their coverage. However, if an individual informs the district of a change that results in an increase in Medicaid coverage, the district is required to process the change.
Any case that is closed will be re-opened and coverage restored to ensure no gap in coverage. If a renewal, notice or other correspondence is returned to the district with no forwarding information, the district must maintain coverage for the case for the duration of this emergency.
The renewal extension applies to all renewal cases including Office of Mail Renewal, Managed Long Term Care, Medicaid Spenddown cases, Nursing Home Eligibility, Medicare Savings Program, and Medicaid Buy-In for Working People with Disabilities.
SSI AND CASH ASSISTANCE/MEDICAID CASES
Former SSI cash cases and any discontinued Cash Assistance/Medicaid cases that require a separate Medicaid eligibility determination will have Medicaid coverage extended. No renewal is required to be sent at this time and no redeterminations are required at this time.
SSI cash cases and any Cash Assistance/ Medicaid cases that require a separate Medicaid eligibility determination will have their Medicaid coverage extended for six months. No redeterminations are required at this time.
Medicaid recipients on the NY State of Health Marketplace who turn 65 will maintain their coverage on the Marketplace for the duration of the emergency, see more information below, Medicaid, Transition of Cases to and from NY State of Health Marketplace (NYSOH).
Local districts should not increase an individual’s spenddown liability, as this is considered a reduction in coverage.
Individuals must continue to meet their surplus requirement if they want to have Medicaid coverage. MAP-3183 (dated 09/02/2021) was sent to all Surplus beneficiaries to this effect.
Individuals who have a spenddown and have been unable to submit a bill or payment due to the COVID-19 emergency should contact their local district; in NYC they should call the MICSA Surplus Helpline at 929-221-0835. The individual should include the following information:
- Phone number
- If submitting a bill, provide the name of the provide, the date of the service, and the amount of the bill
- If submitting a payment, indicate the amount of the payment.
Clients will receive a call back if additional information is needed. If the requested information is provided, coverage will be extended for 6 months.
Transition of Cases to and from NY State of Health Marketplace (NYSOH)
WMS TO NY STATE OF HEALTH
Effective April 2020, upstate transitions from WMS to NYSOH are suspended. For NYC, individuals who are transitioned to NYSOH but who do not gain Medicaid coverage through NYSOH will have their case re-opened on WMS.
NY STATE OF HEALTH TO WMS
The monthly referrals of WMS for those individuals turning 65 with an active Medicaid case on NYSOH were suspended as of March 19, 2020. However, referrals for those turning 65 to NYSOH may still be sent to local districts because another identifier triggered the transition to WMS, such as receipt of community-based long term care services, see immediately below.
MEDICAID MANAGED CARE ISSUES
Prior to the COVID-19 crisis, anyone with Medicare could not remain in a Mainstream Medicaid Managed care plan (MMC), HIV Special Needs Plan (SNP) or a Health and Recovery Plan (HARP). (All these plans cover long-term care services and supports.) At this time, individuals with Medicaid who become Medicare eligible are maintaining their Medicaid coverage through NY State of Health. With a new process called Default Enrollment, some plan enrollees are enrolled in the same Medicare Advantage Dual Special Needs Plan or Medicaid Advantage Plus plan as their Medicaid insurer.
If you are a Benefits Plus Online subscriber, for additional information on Default Enrollment, refer to Health Programs, Medicaid ,Medicaid Managed Care Provisions.
For subscription information visit: https://bplc.cssny.org/home/subscription_options.
Under the Families First Coronavirus Response Act, such individuals now have the following Medicaid options:
Changes to Home Care Services
Home care recipients may want to temporarily reduce their current hours of home care or even pause their home care to limit their exposure to the coronavirus. The NYS Department of Health has issued a directive on April 23, 2020, that states that home care recipients can make a temporary change to their care plan during the COVID-19 emergency by pausing or reducing the number of hours of home care. For more information visit: https://health.ny.gov/health_care/medicaid/covid19/docs/2020-04-23_guide_volplanofcare.pdf.
For additional information on Home Care cases visit: https://health.ny.gov/health_care/medicaid/covid19/docs/2020-03-18_guide_authorize_cb_lt_services.pdf
Medicaid “Emergency Services Only” Coverage for Individuals without Documentation
Medicaid covers emergency services for individuals without documentation. COVID-19 testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals without documentation. There is no copayment for emergency services, including testing, evaluation and treatment for COVID-19.
During the COVID-19 emergency, consumers who requested a fair hearing with aid continuing status on or after March 18, 2020, must be maintained with the same coverage during the period of the emergency.
There is no change to district obligations with regard to fair hearings.
Impact of COVID-19 Cash Aid on Eligibility
Click here for details on how the CARES Act Economic Impact payments (EIP), the American Rescue Plan Act payments, and Pandemic Unemployment Compensation affects benefit eligibility.